Cervicocerebral Artery Dissection Research Articles

Small vessel disease is associated with later onset of major adverse cardiovascular events after acute cervicocerebral artery dissection

BackgroundCerebral small vessel disease (CSVD) is common among the elderly and has been associated with an increased risk of major adverse cardiac events (MACE) and increased risk of long-term disability. Little is known whether CSVD affects outcomes after cervicocerebral artery dissection (CAD), which predominantly affects younger patients. Specifically, there is a paucity as to whether CSVD increases the risk of MACE after CAD and whether this risk is different for early versus late events. MethodsWe retrospectively analyzed 140 consecutive patients with acute CAD. We determined CSVD on MRI using the STRIVE criteria and calculated the CSVD sum score based on the individual CSVD components. For statistical analysis the CSVD burden was dichotomized to mild (score 0–1) versus severe (score 2–4). The primary outcome of interest was the 6-month MACE risk. Secondary outcomes of interest were early versus late MACE, stroke at presentation, and good 90-day outcome (modified Rankin Scale score 0–2). ResultsThere was no difference in overall MACE between subjects when stratified by CSVD burden (10.1% versus 9.8%, Log-rank P = 0.953). We found that patients with severe CSVD had significantly more late MACE as compared to mild CSVD (9.8% versus 1.1%, P = 0.024). There was no significant difference in the prevalence of stroke at the time of CAD diagnosis (50.6% versus 47.1%, P = 0.690) and the 90-day disability-free survival in subjects with mild versus severe CSVD (93.7% versus 91.7%, P = 0.729). ConclusionSevere CSVD burden was associated with a significantly greater risk of late MACE. CSVD assessment in CAD patients may aid risk stratification and treatment optimization.

Headache characteristics to screen for cervicocerebral artery dissection in patients with acute onset unusual headache.

The aim of this preplanned primary analysis was to investigate the clinical manifestations of headache to screen for CAD patients with acute onset headache only. Spontaneous cervicocerebral artery dissection (CAD) with acute onset headache is not rare in clinical practice; however, it is underdiagnosed. On the other hand, subsequent infarction or subarachnoid hemorrhage mainly occurs within 1 week of headache onset. Between April 2017 and January 2022, we conducted a single-center, cross-sectional retrospective study on 197 consecutive referred patients from neurosurgical outpatient clinics with acute onset unusual headache (stronger or longer headache than usual). All patients underwent magnetic resonance imaging to screen for secondary headache and were diagnosed based on the diagnostic protocol. We examined patient background data and the following headache characteristics: distribution, condition at the onset of headache, accompanying vomiting or nausea, worsening headache, and analgesic effects against headache. These factors were analyzed to identify independent diagnostic predictors of CAD. In this study, the rate of missing data was 41% for improvement of headache by analgesia and multiple imputation by chained equations was performed. A total of 93 patients (46 men and 47 women; mean age: 48 years, range: 25-73 years) were diagnosed with CAD. Univariate logistic regression analysis showed CAD was associated with current smoking, systolic blood pressure >140 mmHg, unilateral headache, worsening headache, and no headache improvement by analgesia. Unilateral, worsening headache and no headache improvement by analgesia remained independent diagnostic predictors in multivariable logistic regression after multiple imputation. No headache improvement by analgesia had the highest sensitivity (86%), while worsening headache had the highest specificity (84%). CAD needs to be considered in patients with unilateral, worsening headache and no headache improvement by analgesia.

No direct involvement of Phactr-1 in non-atherosclerotic arteriopathies: results from 3 different Phactr-1 transgenic knockout mice

Abstract Introduction Genome-wide association studies have revealed robust associations of common genetic polymorphisms in the Phactr1 locus (6p24) (encoding Phosphatase and Actin Regulator 1) with cervico-cerebral artery dissection (CCeAD), spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD). These common elements of genetic predisposition provide a proof of concept for important shared mechanisms at the molecular level between CCeAD, SCAD and FMD vascular diseases. Objective Deciphering genetic, molecular and physiological importance of PHACTR1. Method Using various tissue-specific Cre-driver mouse lines, Phactr1 was deleted either in endothelial cells (EC) using 2 tissue-specific Cre-driver (one of them was embryonic) and Smooth Muscle Cells (SMC) with a third tissue-specific Cre-driver to assess its role in the pathogenesis of CCeAD, SCAD or FMD. Results To test the efficacy of the Phactr1 deletion after cre-induction, we confirmed firstly, a decrease in Phactr1 transcription and Phactr1 expression in EC and SMC isolated from Phactr1iPDGFB and Phactr1iSMA mice. Irrespective to the tissue or the duration of the deletion, mice did not spontaneously display pathological phenotype or vascular impairment: mouse survival, growth, blood pressure, large vessel morphology or actin organization were not different in KO mice than their comparatives littermates. Challenging vascular function and repair either by angiotensin-II-induced hypertension or limb ischemia did not lead to vascular morphology or function impairment in Phactr1-deleted mice. Similarly, there was no more consequences of Phactr1 deletion during embryogenesis in ECs. Conclusion Loss of function of PHACTR-1 in the cell types mostly involved in vascular physiology does not appear to induce a pathological vascular phenotype. Funding Acknowledgement Type of funding sources: None.

Vascular headache

Headache is a common accompanying symptom of cerebrovascular diseases, and may represent the only symptom at onset or predominates over the other neurological features. Indeed, the third edition of the International Classification of Headache Disorders (ICHD-3) dedicates an entire chapter to headache attributed to cranial or cervical vascular disorder. It includes headaches attributed to non traumatic intracranial hemorrhage, arterial dissection, acute ischemic stroke, cerebral venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, arteritis and chronic intracranial vasculopathy such as CADASIL or MELAS. Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics. The descriptions may range from a thunderclap onset to a phenotype similar to tension type headache. However, many of these headaches can be present with peculiar characteristics as in the case of thunderclap headache following subarachnoid hemorrhage or cerebral reversible vasoconstriction syndrome. In cervicocerebral artery dissection pain is most commonly ipsilateral to the dissected vessel, mainly perceived in the temporal area in carotid artery dissection and in the occipital area in vertebral artery dissection. Otherwise, pain can mimic primary headaches, mostly migraine, tension-type headache, or cluster headache, as described in the case of vascular artery dissection or symptomatic arteriovenous malformations. Headache may lack specific features as seen in cerebral venous thrombosis. Therefore, it is essential to be aware of the relationship between headache and cerebrovascular diseases, in order to can timely recognise causes and intervene as soon as possible to avoid permanent sequelae that result in disability.

Characteristics of high-resolution magnetic resonance vessel wall imaging of cervicocerebral artery dissection and the influential factors of vascular recanalization.

Cervicocerebral artery dissection (CAD) is one of the important causes for ischemic stroke in young and middle-aged people. CAD is dangerous and untimely diagnosis and treatment are likely to result in severe disability. Early diagnosis and timely intervention can greatly improve the prognosis of patients. This study was to investigate the imaging features of CAD on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) and to analyze the influential factors of vascular recanalization. A total of 19 CAD patients with both baseline HRMR-VWI and follow-up data of vascular imaging in the period from April 2017 to December 2019 in Department of Radiology, Xiangya Hospital, Central South University were retrospectively analyzed. The diseased vessels were divided into a recovery group and a unrecovered group. After treatment, diseased vessels with no residual arterial dissection and no residual stenosis in the lumen were included in the recovery group. Diseased vessels with stenosis, occlusion or residual dissection were included in the unrecovered group. Diseased vessels were divided into a ischemic stroke group and a non-ischemic stroke group according to the presence or absence of ischemic stroke in the area supplied by the diseased vessels. Differences in clinical data and HRMR-VWI imaging findings were compared between the groups. A total of 26 vessels were involved, including 14 (53.8%) internal carotid artery extracranial segment, 8 (30.8%) vertebral artery extracranial segment, 3 (11.5%) vertebral artery intracranial segment, and 1 (3.9%) basilar artery. Ischemic stroke occurred in 16 diseased vascular supply areas. Intramural hematoma was all observed in the baseline HMR-VWI of the affected vessels. There were 18 vessels (69.2%) in the recovery group and 8 vessels (30.8%) in the unrecovered group. Compared with the vessels in the recovery group, the vessels in the unrecovered group were mostly found in the intracranial segment (P<0.05). However, there were no significant differences in gender, age, imaging findings of dissection, length of lesion involvement, time between reexamination, vascular occlusion, and antiplatelet therapy between the recovery group and the unrecovered group (all P>0.05).There were nosignificant differences in age, gender, complication of hypertension, hyperlipidemia, diabetes mellitus, lesion location, vascular occlusion, lesion involvement length, double lumen sign, internal membrane, and lumen thrombosis between the ischemic stroke group and the non-ischemic stroke group (all P>0.05). Intramural hematoma is a common imaging manifestation of CAD and can be shown clearly and accurately on HRMR-VWI. Recanalization rate of CAD is high, and the recanalization of CAD in intracranial segment is slower than that of CAD in extracranial segment, which can prolong the review time.

No direct involvement of Phactr-1 in non-atherosclerotic arteriopathies: Results from 3 different Phactr-1 transgenic knockout mice

Genome-wide association studies have revealed robust associations of common genetic polymorphisms in the Phactr1 locus (6p24) (encoding phosphatase and actin regulator 1) with cervico-cerebral artery dissection (CCeAD), spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD). These common elements of genetic predisposition provide a proof of concept for important shared mechanisms at the molecular level between CCeAD, SCAD and FMD vascular diseases. Deciphering genetic, molecular and physiological importance of PHACTR1. Using various tissue-specific Cre-driver mouse lines, Phactr1 was deleted either in endothelial cells (EC) using 2 tissue-specific Cre-driver (one of them was embryonic) and smooth muscle cells (SMC) with a third tissue-specific Cre-driver to assess its role in the pathogenesis of CCeAD, SCAD or FMD. To test the efficacy of the Phactr1 deletion after cre-induction, we confirmed firstly, a decrease in Phactr1 transcription and Phactr1 expression in EC and SMC isolated from Phactr1 iPDGFB and Phactr1 iSMA mice. Irrespective to the tissue or the duration of the deletion, mice did not spontaneously display pathological phenotype or vascular impairment: mouse survival, growth, blood pressure, large vessel morphology or actin organization were not different in KO mice than their comparatives littermates. Challenging vascular function and repair either by angiotensin-II-induced hypertension or limb ischemia did not lead to vascular morphology or function impairment in Phactr1-deleted mice. Similarly, there was no more consequences of Phactr1 deletion during embryogenesis in ECs. Loss of function of PHACTR-1 in the cell types mostly involved in vascular physiology does not appear to induce a pathological vascular phenotype.

Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection

Spontaneous cervicocerebral artery dissection (sCCD) is an important cause of ischaemic stroke that often occurs in young and middle aged patients. The purpose of this study was to investigate the correlation between tortuosity of the carotid artery and sCCD. Patients with confirmed sCCD who underwent computed tomography angiography (CTA) were reviewed retrospectively. Age and sex matched patients having CTA were used as controls. The tortuosity indices of the cervical arteries were measured from the CTA images. The carotid siphon and the extracranial internal carotid artery (ICA) were evaluated according to morphological classification. The carotid siphons were classified into five types. The extracranial ICA was categorised as simple tortuosity, coiling or kinking. Independent risk factors for sCCD were investigated using multivariable analysis. The study included sixty-six patients with sCCD and 66 controls. There were no differences in vascular risk factors between the two groups. The internal carotid tortuosity index (ICTI) (25.24±12.37 vs. 15.90±8.55, respectively; p<.001) and vertebral tortuosity index (VTI) (median 11.28; interquartile range [IQR] 6.88, 18.80 vs. median 8.38; IQR 6.02, 12.20, respectively; p=.008) were higher in the patients with sCCD than in the controls. Type III and Type IV carotid siphons were more common in the patients with sCCD (p=.001 and p<.001, respectively). The prevalence of any vessel tortuosity, coiling and kinking of the extracranial ICA was higher in the patients with sCCD (p<.001, p=.018 and p=.006, respectively). ICTI (odds ratio [OR] 2.964; p=.026), VTI (OR 5.141; p=.009), and Type III carotid siphons (OR 4.654; p=.003) were independently associated with the risk of sCCD. Arterial tortuosity is associated with sCCD, and greater tortuosity of the cervical artery may indicate an increased risk of arterial dissection.

Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

BackgroundCervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD.MethodsAll cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared.ResultsA total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041).ConclusionsThe distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.

Headache in cervicocerebral artery dissection.

Cervicocerebral artery dissection (CAD) is one of the more frequent causes of stroke in young adults with rates of up to 25%. Predisposing and risk factors for CAD are very different, and an etiological classification is based on the presence of a previous minor or major trauma, differentiating traumatic from spontaneous CAD. Headache represents one of the main initial symptoms for this pathological condition, probably due to the release of pro-inflammatory neurotransmitters from nerve terminals near the injured vessel. For its peculiar characteristics, the headache due to CAD has been defined with specific ICHD-3 criteria. In many cases, headache is associated with other signs related to the dissection or cerebral ischemia. In this systematic review of literature, headache was reported in more than 70% of cases with CAD with a prevalence in vertebrobasilar dissections. More than half of patients suffered a severe pain that was usually located in fronto-temporal and occipito-nuchal regions in the case of dissections in the anterior and posterior circulation, respectively. For the high stroke risk, CAD has to be promptly diagnosed with MRI or CTA and treated with anticoagulants or antithrombotics.

Clinical characteristics and risk factors analysis of intracranial and extracranial arterial dissection

Objective: To compare and analyze the clinical features and potential risk factors of intracranial and extracranial arterial dissection. Methods: A total of 241 consecutive patients with cervicocerebral artery dissection (CAD) in the First Affiliated Hospital of Zhengzhou University from 2010 to 2019 were observed. The 241 CAD patients were divided into extracranial artery dissection group (EAD) (n=81) and intracranial artery dissection group (IAD) (n=160), clinical characteristics and risk factors were compared between the two groups. Results: Compared with EAD, the National Institute of Health Stroke Scale (NIHSS) score was higher in patients with ischemic stroke in the IAD group (P=0.015). Patients with IAD were more likely to present with headache (58.8% vs 37.0%, P<0.001), and dissection Aneurysms (76.3% vs 38.3%, P<0.001). Patients with EAD more likely to have a history of mild head and neck injuries (11.1% vs 4.4%, P=0.047) and often involved the anterior circulation (77.8% vs 20.0%, P<0.001). Multivariate Logistic regression analysis showed differences in a history of minor head and neck trauma (OR=3.53, 95%CI 1.04-11.97, P=0.042), anterior circulation involvement (OR=0.09, 95%CI 0.05-0.19, P<0.001), dissection aneurysms (OR=4.98, 95%CI 2.80-8.84, P<0.001), headache (OR=2.42, 95%CI 1.39-4.20, P=0.002) remained significant, and the NHISS score lost its significance. Conclusions: EAD often involves the anterior circulation and a history of mild injury to the head and neck. IAD is more prone to exhibit headache symptoms, and it is more likely to form a dissection aneurysm, and the symptoms of ischemic stroke are more severe.

Abstract WP173: Characteristics and Prognostic Factors for the Imaging Outcomes in Cervicocerebral Artery Dissection

Introduction: Although cervicocerebral artery dissection is a common cause of ischemic stroke in young adults, the effectiveness of imaging findings in predicting outcomes is not well established. We aimed to identify the baseline characteristics and imaging outcomes as well as prognostic factors which influence imaging outcomes for cervicocerebral artery dissection. Methods: We included 190 consecutive patients who presented with ischemic symptoms associated with cervicocerebral artery dissection on baseline vascular images. Imaging findings on the baseline were obtained within 7 days after symptom onset, and follow-up vascular images were performed at 3 months, 6 months, or 1 year. We compared the imaging features and the degrees of recovery (complete or partial recovery) between the baseline and follow-up vascular images. Results: A total of 133 patients who underwent vascular imaging at baseline and either 6 months or 1 year were compared for these analyses. The median interval between baseline symptom onset and the first vascular imaging was within 24 hours (IQR 0, 1). Regarding the lesion sites, a dissection was more common in the intracranial arteries (78.2%) than the extracranial (21.8%). The most common site of dissection was the vertebral artery (51.1%) with V4 being the most common (38.3%). Follow-up images showed partial or complete improvement of the dissected vessels in 53% (95% CI, 42-63%) at 6 months and 91% (95% CI, 83-95%) at 1 year. The lesions with stenotic/occlusion revealed better imaging recovery compared with lesions with an aneurysm (67.6% vs. 21.3% at 6 months, p&lt;0.002; 85.7% vs. 27.7% after 1 year, p&lt;0.002). After adjustment for the age, gender, and eGFR, a multivariate analysis proved that dyslipidemia (OR 8; 95% CI, 2.6-24.4; p&lt;0.001) and a lesion site on the vertebral artery (OR 2.6; 95% CI, 1.1-6.1; p=0.026) were independent predictors of poor imaging outcome. Conclusions: In patients who were diagnosed with cervicocerebral artery dissection based on baseline vascular images, the rate of complete or partial improvement was over 50% in the 6-month follow-up images. Dyslipidemia and vertebral artery dissection were poor prognostic factors for the recovery of the vascular lesion after cervicocerebral artery dissection.

Characteristics and relative factors of headache caused by cervicocerebral artery dissection.

To analyze the characteristics and relative factors of headache and neck pain due to cervicocerebral artery dissection (CAD). A total of 146 consecutive patients with CAD in Zhengzhou, China (2010-2017) were observed and registered prospectively. There were 60 (60/146) cases who complained of headache and neck pain, and we analyzed the characteristics of pain according to their clinical features. For the 130 (130/146) patients with complete clinical laboratory data, they were divided into two groups according to pain, and the relative factors of pain were analyzed. The headache and neck pain in 60 CAD patients was mostly acute onset (98.3%), 70.6% (12/17) of patients with anterior circulation dissection and 88.4% (38/43) of patients with posterior circulation dissection complained of moderate to severe pain. 41.2% (7/17) of patients with anterior circulation dissection had temporal pain, while 46.5% (20/43) of the patients with posterior circulation dissection had occipital pain. There were 23.5% (4/17) and 32.6% (14/43) of patients with anterior and posterior circulation dissection complained of throbbing pain, respectively, 23.5% (4/17) and 20.9% (9/43) of patients with anterior and posterior circulation dissection complained of pulsating pain. The pain could occur in the ipsilateral (40.0%), bilateral (52.7%), or contralateral (7.3%) sites of the dissection. In the 130 patients, there were 56 cases (43.1%) in the pain group, and 74 cases (56.9%) in the non-pain group. Multivariate logistic regression analysis showed that female gender (OR 4.01, 95% CI 1.63-9.85, P = 0.002), posterior circulation (OR 3.18, 95% CI 1.39-7.28, P = 0.006), history of headache (OR 4.72, 95% CI 1.08-20.52, P = 0.039), and low-density lipoprotein less than 1.8mmol/L (OR 2.90, 95% CI 1.15-7.34, P = 0.025) were risk factors of the occurrence of the pain related to CAD. The headache and neck pain caused by CAD is a moderate to severe pain occurring suddenly. The pain nature may be diverse but mostly like throbbing and pulsating. When the dissected artery is located in the posterior circulation, the pain is mostly in the occipital region, and mostly in the temporal region when the dissected artery is located in the anterior circulation. The pain can occur in ipsilateral, bilateral, or contralateral of the dissection. In addition, several factors might contribute to the occurrence of headache and neck pain.

The Headache and Neck Pain in Ischemic Stroke Patients Caused by Cervicocerebral Artery Dissection. A Case-Control Study

Background and purposeThe symptom of headache and neck pain is common in patients with cervicocerebral artery dissection (CAD). We attempt to screen ischemic stroke patients with CAD based on the characteristics of the pain. MethodsEighty-one consecutive ischemic stroke patients with CAD from 2010 to 2017 and 84 consecutive ischemic stroke patients with large artery atherosclerosis (LAA) were registered prospectively and observed in Zhengzhou, China. Those ischemic stroke patients complained of headache and neck pain were categorized into 2 groups. By analyzing the difference of headache and neck pain in 2 groups, we summarized characteristics of the pain secondary to CAD. ResultsThere were 34 patients in CAD group and 19 patients in LAA group. As for patients in CAD group, the pain could be located in the ipsilateral (41.9%), bilateral (41.9%), or contralateral (16.1%) side of the dissected artery, but in LAA group the pain was often in both sides (68.4%). When the dissected artery was involved in anterior circulation, 55.6% of CAD patients had pain in temporal and when involved in posterior circulation, 65.2% of CAD patients had pain in the occipital and neck. Patients with CAD had a higher prevalence of throbbing pain (30.0%), while pulsating pain (43.8%) was more common in LAA group. Patients often presented with severe pain (46.9%) in CAD group, while less frequently (11.8%) in LAA group, with a significant difference (P = .003). And there was a significant difference between the length (≥20 mm) of the involved artery and severity of the pain (P = .028) in CAD group. ConclusionsIschemic stroke patients caused by CAD tend to suffer from headache and neck pain, which may be severe and throbbing, compared with those resulting from LAA. The anterior circulation dissection has a higher prevalence of temporal pain while posterior circulation dissection is typically more associated with occipital and neck pain.

A case-control study of the determinants for cervicocerebral artery dissection.

Cervicocerebral artery dissection (CAD) is a major cause of ischemic stroke in young adults. There are many existing studies on determinants for CAD; however, they are still not totally defined. We conduct the study to further investigate the determinants for CAD based on ischemic stroke patients. 81 ischemic stroke patients with CAD were enrolled in the CAD stroke group and 84 ischemic stroke patients without CAD were enrolled in the non-CAD stroke group. Their clinical data, such as age, gender, vascular risk factors, headache and neck pain and clinical laboratory data, were collected to analyze the differences between the two groups. A total of 165 ischemic stroke patients were included. The mean age of CAD stroke group was (51.6 ± 12.4) years, and (55.5 ± 8.1) years in non-CAD stroke group, with a statistically significant difference (P = 0.017). The average level of triglycerides in CAD stroke group was (1.3 ± 0.7) mmol/L, and (1.7 ± 1.1) mmol/L in non-CAD stroke group, with a statistically significant difference (P = 0.012). There were 42.0% (34/81) of headache and neck pain in CAD stroke group and 22.6% (19/84) in non-CAD stroke group, with a statistically significant difference (P = 0.008). The key findings with significant difference were stratified and multivariate logistic regression analysis showed that age < 50years old (OR 2.98, 95% CI 1.43-6.21, P = 0.004), triglycerides < 1.6mmol/L (OR 3.51, 95% CI 1.69-7.27, P = 0.001) and headache and neck pain (OR 2.94, 95% CI 1.39-6.20, P = 0.005) showed a positive correlation with CAD. In the process of diagnosis and treatment of ischemic stroke, for patients with age < 50years old, headache and neck pain and triglycerides < 1.6mmol/L, the cervicocerebral artery dissection should be considered, and vascular imaging examination needs to be performed in time.

P6-4 - Vascular imaging features and outcomes of acute cervicocerebral artery dissection

【Objectives】We investigated the angiographic outcomes and prognostic factors for imaging features of acute cervicocerebral artery dissection.

Abstract TP213: Initial Vascular Lesion Patterns on Early Images Would Predict Vascular Outcomes in Acute Cerebral Artery Dissection

Introduction: Imaging characteristics and prognosis on the follow-up imaging in patients with acute cervicocerebral artery dissection are not well established. Hypothesis: Initial lesion patterns on early vascular imaging would predict vascular imaging outcomes in acute cervicocerebral artery dissection. Methods: Individual clinical data and imaging features were obtained from 167 consecutive patients who presented with acute ischemic symptoms or headache due to cervicocerebral artery dissection. Patients were categorized according to their baseline vascular imaging features as either Stenosis Only, Aneurysm Only, or Both Stenosis and Aneurysm. The angiographic characteristics and improvements of early vascular lesions between baseline (within 7 days after symptoms onset) and follow-up vascular images (6-month or 1-year after symptom onset) were compared. Results: A total of 76 patients who underwent baseline and 6-month or 1-year vascular imaging were included. Patients in the Stenosis Only group (n=36) were younger (mean age, 45±11) than those in the Aneurysm Only (n=9, 55±7) and Both Stenosis and Aneurysm (n=31, 48±12) groups (p=0.044). The most common sites of lesions were the distal vertebral artery and posterior inferior cerebellar artery (n=43, 57%). All patients in Aneurysm Only group had their lesions in the posterior circulation (61% in Stenosis Only, 77% in Both Stenosis and Aneurysm; p=0.047). A total of 43 patients (57%) showed improvement of initial lesions on follow-up vascular images (58% in Stenosis Only vs. 22% in Aneurysm Only vs. 65% in Both Stenosis and Aneurysm; p=0.076). The proportion of patients who obtained improvements on follow-up vascular images on baseline images was lower in Aneurysm Only compared with groups with stenosis (Stenosis Only and Both Stenosis and Aneurysm) (Odds ratio 0.18, 95% CI 0.03 to 0.94; p=0.035). Conclusions: Complete or partial improvements on follow-up images are obtained in over half of the patients with acute cervicocerebral artery dissection. Patients with only aneurysm on early images showed poor imaging prognosis compared to patients with stenosis.

TGFBR2 mutation and MTHFR-C677T polymorphism in a Mexican mestizo population with cervico-cerebral artery dissection

Spontaneous cervico-cerebral artery dissection (CCAD) is a common condition found among young patients with ischemic stroke. We examined the possible association between the polymorphism of methylenetetrahydrofolate reductase (MTHFR)-C677T and the gene mutation in transforming growth factor beta receptor II (TGFBR2) in a cohort of CCAD patients. One-hundred CCAD cases (65 males; mean age: 38.08±10.68years) and 100 matching controls were included. Ancestry informative markers (AIMs) were used to increase internal validity of the genetic analysis. Genotypes of the C677T polymorphism in the MTHFR gene were determined by polymerase chain reaction and restriction fragment length polymorphism; direct sequencing was used for a mutation analysis of the TGFBR2 gene. Associations were evaluated using a multivariate statistics, and Hardy-Weinberg equilibrium was analyzed. We also incorporated our data into a meta-analysis of the MTHFR-C677T. Sixty-three patients presented with vertebral and 37 with carotid artery dissection. Ancestry markers found a call rate on each over 95%. All AIMs did not deviate from Hardy-Weinberg equilibrium (p>0.05). The homozygous TT genotype was more frequent in cases (OR 2.04, CI 95% 1.53-2.72, p=0.005), whereas no significant difference was found on heterozygous CT genotype. TGFBR2 mutation was not present in our samples. In the meta-analysis of MTHFR/C677T variant, a total 613 cases and 1547 controls were analyzed; we found a moderate association for the recessive model genotype (OR 2.04, CI 95% 1.53-2.72; p=0.342; Z=4.83; I (2)=11.3). This study supports a positive association between the MTHFR-C677T polymorphism and genetically confirmed Mexican mestizo CCAD patients.

Abstract WP221: Imaging Features and Prognostic Factors for Determining Outcomes in Cervicocerebral Artery Dissection

Introduction: Imaging findings for the improvement of prognosis are not well established in patients with cervicocerebral artery dissection. Hypothesis: We aim to identify the imaging outcomes of cervicocerebral artery dissection and prognostic factors which influence improving the imaging outcomes. Methods: We included 162 consecutive patients diagnosed with cervicocerebral artery dissection on baseline vascular images. Imaging findings on the baseline were obtained within 7 days after symptoms onset, and follow-up vascular images were performed 6 months or 1 year. We compared the radiological features and the degrees of recovery (complete or partial recovery) between baseline and follow-up vascular images. Results: A total of 70 patients who underwent baseline and 6-month or a year vascular imaging were compared for these analyses. The patient mean age was 48 (SD 11), and the number of females was 21 (30%). The site of a dissection was more common in the posterior circulation (71.4%) and presence of infarction on baseline MRI was 84%. Regarding the lesion sites, a dissection was more common in the intracranial (83%). The baseline vascular images identified an aneurysm in 40% and stenosis or occlusion in 77%. Follow-up images showed complete improvement of the dissected vessels in 78% at 3 months and 83% at 6 months. Patients (n=15) who had an occlusion on the baseline images had partial or complete resolution in 38%. There were no significant differences in efficacy for the partial or complete improvement of vascular lesion on the follow-up images in patients who were treated with antiplatelet (OR=0.68 [0.15-3.10], p=0.72) or anticoagulation treatment (OR=1.38 [0.48-3.97], p=0.60). In the multivariate analysis, the odds ratio for complete or partial improvement on the follow-up vascular images from vertebral artery was 0.16 (0.48-0.52) (p=0.002) after adjustment for age, gender, and eGFR. Conclusions: In patients who diagnosed with cervicocerebral artery dissection on baseline vascular images, the rate of complete or partial recanalization was over 80% on the 6-month or 1-year follow-up images. Vertebral artery dissection are poor prognostic factors for the recovery of the vascular lesion after cervicocerebral artery dissection.

Abstract TP217: Different Features of Anterior and Posterior Circulation Dissections

Introduction: The features of vascular images and risk factors might be different according to the location of the cervicocerebral artery dissection. Hypothesis: We investigate whether the risk factors, neuroimaging features, and imaging outcomes differ according to the dissection site (anterior vs. posterior circulation). Methods: Consecutive patients who presented with ischemic symptoms and underwent brain vascular imaging within seven days after the onset of symptoms were enrolled. Demographic characteristics, putative risk factors, imaging findings, and types of antithrombotic medication were assessed between anterior circulation dissection (ACD) and posterior circulation dissection (PCD). The baseline and follow-up vascular images (6 months or 1 year after the onset of symptoms) were compared to determine the prognostic difference in the reverse of the lesion. Results: A total of 117 patients (n=32 with ACD and n=85 with PCD) were eligible for these analysis. The median delay from symptom onset to baseline vascular imaging was a day (IQR 1, 2). Patients with PCD were older (OR=1.5 by increasing 10 years old [1.02-2.03], p=0.038) and had a dissection associated with exercise or neck manipulation more frequently (OR=4.8 [1.2-18.1], p=0.019) compared to patients with ACD. Arterial stenosis or occlusion was the most common imaging feature (94% in ACD vs. 86% in PCD, p= 0.345). Aneurysm or pseudoaneurysm was identified in 9.4% of ACD and 24.7% of PCD (p=0.067). Among patients with PCD, vertebral artery was the most common lesion site (65% [53-74%]). The complete reverse on the follow-up images at the 6 months or 1 year was identified in 9 patients with ACD and 11 patients with PCD (45% vs. 22%, p=0.054). Neither anticoagulation nor antiplatelet demonstrated significant differences between the frequency of the complete reverse on the follow-up vascular images in patients with ACD and PCD (33% vs. 21%, p=0.613 for anticoagulation; 44% vs. 23%, p=0.087 for antiplatelet). Conclusions: These results substantiate the difference in the risk factors and radiologic features according to the dissection site. There was no difference in efficacy of antiplatelet and anticoagulant drugs at complete reverse of the lesion after cervicocerebral artery dissection.

Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).

Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60% men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73%. Stroke aetiology was mostly cardioembolism (32%) and of other defined origin (24%), including cervicocerebral artery dissection (17%). Fabry disease was diagnosed in 2 patients (0.3%). Aetiology remained unknown in 20%. Outcome at 3 months was favourable (mRS 0-1) in 61% and fatal in 2.9%. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7%. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.